"Pain Management panel is closed", now what? Need serious advise.

[Papa Lou]

fear is a bad disease that limits a lot of our potential...

FEAR = False Evidence Appearing Real


...just kidding I'm not that guy

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[Jcm800]

United health care is great at stalling payments, paying selective codes, delaying others, asking for clinical notes, etc... All with the hope your biller gives up... As I mentioned in prior threads, I was fed up and called it quits when they tried to force their Aca plan into the mix. I gave them the middle finger and they gave me a contractual raise after ten years... You need to fight these pricks, we have some power... It depends on your market and competition, which is getting bleak with the consolidation of hc

Shockingly, we do well with UHC in network payments. They rarely deny us on what we know they pay for. They don't pay for occipital blocks, which is weird...

But they pay us for ESIs, facets pretty well and consistently. They are a pain for RF. and because we are in network and most are not with UHC, in our area, we get a lot of patients that way. Often good patients with legit issues. So I am actually pretty happy with United.

 

[Stim4me]

Shockingly, we do well with UHC in network payments. They rarely deny us on what we know they pay for. They don't pay for occipital blocks, which is weird...

But they pay us for ESIs, facets pretty well and consistently. They are a pain for RF. and because we are in network and most are not with UHC, in our area, we get a lot of patients that way. Often good patients with legit issues. So I am actually pretty happy with United.

That's great... In ours state they dropped 2500 physicians out of network, don't pay their advantage MC bills, and stall payments daily... Makes no sense

 

[Jcm800]

yeah its by no means perfect, but i cant say its the worst. In fact for years i have wondered why others in my area ARE not in network. perhaps they couldnt get in? i dont know. So for now, as long as its not an occpital block, or a repeat RF, its been ok.

 

[Stim4me]

yeah its by no means perfect, but i cant say its the worst. In fact for years i have wondered why others in my area ARE not in network. perhaps they couldnt get in? i dont know. So for now, as long as its not an occpital block, or a repeat RF, its been ok.

United dropped close to 3000k doctors to cut their costs and improve profits... Our attorney general stepped in and reprimanded united... That's no joke. Since insurances cannot discriminate for pre existing conditions, they drop physicians with costly patient care... That's dirty...and probably why they are restricting pain physicians from network panels...

 

[drpainfree]

the UH panel for pain management is closed in my area as well (southern California)

 

[Ducttape]

They asked me to join in my area. Go figure.

 

[PinchandBurn]

An update from my earlier posts from Feb 2015: I wrote whole bunch of complaints to the headquarters of UHC in Minnesota, spoke to their Provider relationship advocate at their headquarters, that got me nowhere. I got a polite letter from UHC that I've "exhausted 3 appeal attempts" and should just crawl into a corner and die. Well, I didn't. I applied for a TN Medical Association membership (it's the biggest group of MDs here in TN). Once I became a member, I spoke to their provider advocate, she had some connections at UHC. I wrote a LOOOONG angry letter for her to forward to her UHC contacts at their high levels of hierarchy . After that, time passed and I kinda forgot about the whole UHC thing ("to Hell with it"). Well, 2 weeks ago I got a contract with UHC in the mail. Signed it and I am effective as of 8/22/15.

Not sure if that was her, or just multiple appeal letters but I got my contract.

BTW, Being OON sucked, I had a few UHC OON pts and besides paying $50 copays, essentially entire visit cost went toward their OON deductable which is huge and they were on a hook for it. So I couldn't even offer them a simple TPI let alone ESI. All I did was 99213 visits and pts were complaining constantly. Lost a few to competition, loyal ones changed to other insurances that I do take in network.

The moral of the story: never give up, if you knock on many doors, one of them will open up.

BTW Love being solo, just got my website up and running. It's also in my profile, would welcome any suggestions on how to improve it from the seasoned guys. Saw 35 pts today, we were running non-stop, thinking about hiring a PA and expansion plans.

thanks guys for all the advice in previous posts.

Congrats! Great to hear your success story and also nice website.
I was always under the impression that your UHC contracts, etc followed YOU as the physician. HOwever, from what you suggest it seems like it follows the 'tax id". So are you suggesting if we work for a hospital but want to leave, we may have the same problems you had even though we are 'in network' with all the insurances currently?

 

[ferning]

You can put anything in u want in a contract. It doesnt mean its legal and enforceable in a court, but all companies and employers do it anyway. it still prevents people from adhering to noncompetitive clauses and these practice constraints. If docs had the time and money to pursue it in court they would win with monetary damages. Just treat ur patients better then they treat u as this topsy turvy world will come around again